Individual
THERESA M NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2570 LAKESHORE CIR, PORT CHARLOTTE, FL 33952-4116
(941) 258-0995
Mailing address
2570 LAKESHORE CIR, PORT CHARLOTTE, FL 33952-4116
(941) 258-0995
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
MA#54341
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA 54341
MASSAGE THERAPIST
FL
Enumeration date
05/07/2009
Last updated
05/07/2009
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